damage control surgery

damage control surgery

TRAUMA SURGERY

Definition A popular term for the immediate closure of a surgical field in a multitrauma patient after the major vascular injuries and other sources of life-threatening bleeding have been repaired; the patient is returned to the OR for definitive surgical repair after the physiologic derangements of hypothermia, acidosis, and coagulopathy have been corrected in the SICU.

Bailout is now regarded as the optimal philosophy for managing severely injured patients, based on the recognition that there is a greater tendency for multitrauma patients to “go sour”; institution of damage control implies immediate control of life-threatening haemorrhage, placement of chest tubes, thoracic packing if needed, closure of the skin if the chest has been opened, hepatic packing, temporary duodenal and hollow viscus closures or rapid stapled resections, drainage of pancreatic injuries, rapid stapled resection of pancreatic injuries if present to the left of the superior mesenteric artery, rapid splenectomy and nephrectomy or occlusion of their vascular pedicles with a vascular clamp left in situ, use of intraluminal shunts, and judicious abdominal packing with temporary abdominal wall closures.